ED Coding and Reimbursement Alert

Question: Is there a CPT code for inguinal hernia reduction performed in the ED under conscious sedation? Also, our doctor reduced an umbilical hernia in the ED (the patient is 42 years old). Is there a CPT code for that or just the evaluation and management (E/M)? Would it be appropriate to use 49585 as the surgical code?

Washington Subscriber

Answer: There is no code for hernia reduction. It is rolled into the evaluation and management (E/M) code. If documentation is adequate, you may also code the conscious sedation.

For more information on coding for conscious sedation, see the November 2000 ED Coding Alert, Justify Use of Conscious Sedation Codes With Thorough Documentation to Get Payment, page 81.

The umbilical hernia reduction is also rolled into the level of service. Only an E/M would be appropriate. Code 49585 (repair umbilical hernia, age 5 years or over; reducible) is meant for open/operative hernia repair.


Sources for Reader Questions and You Be the Coder: Jennifer Nelson, NCMA, CCS-P, independent coding consultant in Corinna, Maine; Penny Lodes, CPC, independent coding consultant, Appleton, Wis.; Michael Granovsky, MD, chief financial officer of Greater Washington Emergency Physicians, a five-physician group staffing a 24,000-visit ER in Maryland; Jan Loomis, director of coding and documentation at Team Health West, Pleasanton, Calif.; Linda Jackson, CCS, CPC, Medicare consultant, Iowa Veterans Home, Marshall Town, Iowa; Caral Edelberg, CPC, CCS-P, president of Medical Management Resources Inc., an emergency department coding consulting firm in Jacksonville, Fla.; John Turner, MD, PhD, medical director for documentation and coding, healthcare financial services at TeamHealth, an ED staffing firm in Knoxville, Tenn.